The role of Fibreoptic Bronchoscopy (FOB) in the evaluation of chronic cough

Background: Chronic cough can be debilitating and it accounts for significant number of referrals to outpatients. There is no consensus as to the best diagnostic strategy and may vary between centres. We assessed the clinical utility of FOB in the evaluation of chronic cough. Methods: Patients with chronic cough and no other clinical or radiological indications for FOB and underwent the procedure (2009-2016) were identified from the electronic records. We excluded patients who did not have a CT Thorax (CT) or had abnormal CT that could be associated with cough. Results: 56 patients (males-51%), mean age 59 years were included.24(42%) were current or ex-smokers. The median (IQR) duration of cough was 20(9-42) months. 1 patient had previous history of extra thoracic malignancy.16(28%) had evidence of obstructive spirometry. Chest radiograph was normal in 45(79%). CT was normal in 31(54%).Other CT abnormalities were lung nodules, Emphysema, atelectasis, pleural plaques, mediastinal nodes and fibrotic bands. FOB was normal in 52(91%).Other abnormalities seen were secretions, distorted vocal cords, areas of inflammation and bleeding. Bronchial washings were done in 10(18%), Transbronchial needle aspiration with EBUS and endobronchial biopsies done in 1 patient each. None of the samples showed any significant cytological, histological or microbiological abnormalities. The final diagnosis were airways disease 7(13%), acid refux-8(14%) and unexplained cough-36(63%).24(42%) required referral to specialist cough clinic. Conclusion: FOB adds little to the diagnosis of chronic cough in the context of normal or non-localising CT findings. The diagnosis and treatment of chronic cough remains a challenge.